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Ethical Dilemma

Assistant lecturer: Hussein M. A. Al-Tameemi

‫م حسين منصور علي التميمي‬.‫م‬
 An ethical dilemma or ethical paradox is a decision-making problem
between two possible moral imperatives, neither of which is
unambiguously acceptable or preferable.

 The complexity arises out of the situational conflict in which obeying one
would result in transgressing another. Sometimes called ethical paradoxes
in moral philosophy, ethical dilemmas may be invoked to refute an
ethical system or moral code, or to improve it so as to resolve the

By the very nature of an ethical dilemma, there is no one

good solution, and the decision made often has to be

defended against those who disagree with it.


An ethical dilemma is a situation that requires an individual

to make a choice between two equally unfavorable
Examples of Ethical Dilemma in
Patient Freedom Versus Nurse Control

 Nurses are highly educated and therefore aware of the best clinical
course of action when one exists. But what happens when a patient
rejects medical advice and makes a decision that may result in less
optimal outcomes?

 From deciding whether or not a labor and delivery patient would benefit
from pain medication, to encouraging a patient to eat when they are
refusing food, nurses walk a fine line everyday.
Patient Freedom Versus Nurse Control

 While nurses do not sign the Hippocratic Oath, they are

still bound by the promise to devote themselves to the welfare
of the patients committed to the care, as well as to live up to
the standards of the profession.

The argument rages even today about whether or not people

have the right to die when they choose to die.

Do patients who are terminal and suffering have the right to

die through assisted suicide?

Nursing is about promoting quality care and saving lives

through resources and our own caring capacity for other people.
How should nurses approach the topic of assisted suicide?
Lying to Patients

It is not uncommon for a family member to demand

that their loved one not be told they have a terminal
illness. It is equally tempting for healthcare professionals
to shine the reality by telling a patient that they are worse
off than they truly are.
The Battle of Beliefs

Empirical Knowledge and Personal Belief

What is science-based, empirical knowledge to a nurse might be completely

subjective to a patient with a particular set of religious or personal beliefs.
Certain religions forbid medical procedures which can mean the difference
between life and death. For example, in some cultures and religions, blood
transfusions – even lifesaving ones – are unacceptable.
Utilization of Resources

Resources are defined as tools used to provide patient care. Those

tools include bed space, government reimbursements, funding, etc.

How should nurses approach ethical dilemma when patients are

utilizing resources that might be better used on another patient or
population of patients. The example for this dilemma would be a
patient that has no brain function, is on life support and has been for
several years.
Other dilemmas

1) Inappropriate Medication Orders

2) Unresponsive Physicians

3) Inappropriate Tasks
Scenario of Ethical Dilemma in Nursing

 Patient has stevens-johnson syndrome with uncertain prognosis (50/50 chance). pt

arrests, is unconscious vented and needs dopamine to maintain her bp constantly. pt
revealed to family and nurse prior to arrest that she doesnt wish to be kept alive
should she become a "vegetable". she also has an advanced care directive stating that
should she become terminal, she doesn't wish for life sustaining measures. nurse says
to doctor that perhaps we should discontinue treatment in accordance with pt and
family wishes. doctor says no. but nurse hangs a bag of normal saline, labels it
dopamine, pt arrests and dies. was this ethical?
Despite the nurses ability to deal with patients’ physical
problems, many nurses feel inadequate when confronted
with ethical dilemmas associated with patient care. These
feelings may stem from their unfamiliarity with a
systematic problem-solving technique for ethical dilemmas.
Ethical Decision

The ethical decision-making process provides a method for nurses

to answer key questions about ethical dilemmas and to organize

their thinking in a more logical and sequential manner.

The problem-solving method presented here, unlike some others, is based on

the nursing process. It should be relatively easy for the nurse to move from

the nursing process used in resolving patient physical problems to the ethical

decision making process used in resolving ethical problems.

Nursing process


Evaluation Diagnosis

Implementation Planning
Five-step Ethical Decision Making
 Step 1: Collect, Analyze, and Interpret the Data.

 Step 2: State the Dilemma.

 Step 3: Consider the Choices of Action.

 Analyze the Advantages and

 Disadvantages of Each Course of Action.

 Step 5: Make the Decision.